Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment of relapsed and refractory Hodgkin's lymphoma, but they are associated with immune-related adverse effects (irAEs). Although rare, ocular irAEs can have a significant impact on vision. This is the case of a 29-year-old female with relapsed classical Hodgkin's lymphoma, who experienced unilateral, painless vision loss after two cycles of pembrolizumab-based therapy. The MRI revealed optic nerve inflammation and extensive investigations ruled out other causes. A diagnosis of immune-related optic neuropathy was made. Pembrolizumab was stopped, and high-dose intravenous methylprednisolone was immediately started, followed by a six-week prednisolone taper, which resulted in complete visual recovery within two weeks. The patient achieved remission with DHAP chemotherapy before receiving autologous stem cell transplantation. This case emphasises the necessity of early identification and prompt corticosteroid treatment for ocular immune-related adverse events, underscoring the requirement for meticulous surveillance and swift action to avert permanent vision impairment.
References
1. Chen R, Zinzani PL, Lee HJ, Armand P, Johnson NA, Brice P, et al. Pembrolizumab in relapsed or refractory Hodgkin lymphoma: 2-year follow-up of KEYNOTE-087. Blood 2019;134(14):1144–53. doi:10.1182/blood.2019000324.
2. Kuruvilla J, Ramchandren R, Santoro A, Paszkiewicz-Kozik E, Gasiorowski R, Johnson NA, et al. Pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma (KEYNOTE-204): an interim analysis of a multicentre, randomised, open-label, phase 3 study. Lancet Oncol 2021;22(4):512–24. doi:10.1016/S1470-2045(21)00005-X.
3. Haanen J, Obeid M, Spain L, Carbonnel F, Wang Y, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology 2022;33(12):1217–38. doi:10.1016/j.annonc.2022.10.001.
4. Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021;9(6):e002435. doi:10.1136/jitc-2021-002435.
5. Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. Journal of Clinical Oncology 2021;39(36):4073–126. doi:10.1200/JCO.21.01440.
6. Noble CW, Gangaputra SS, Thompson IA, Yuan A, Apolo AB, Lee J-M, et al. Ocular Adverse Events following Use of Immune Checkpoint Inhibitors for Metastatic Malignancies. Ocul Immunol Inflamm 2020;28(6):854–9. doi:10.1080/09273948.2019.1583347.
7. Bomze D, Meirson T, Hasan Ali O, Goldman A, Flatz L, Habot-Wilner Z. Ocular Adverse Events Induced by Immune Checkpoint Inhibitors: A Comprehensive Pharmacovigilance Analysis. Ocul Immunol Inflamm 2022;30(1):191–7. doi:10.1080/09273948.2020.1773867.
8. Telfah M, Whittaker TJ, C. Doolittle G. Vision loss with pembrolizumab treatment: A report of two cases. Journal of Oncology Pharmacy Practice 2019;25(6):1540–6. doi:10.1177/1078155219841683.
9. Zhou R, Caspi RR. Ocular immune privilege. F1000 Biol Rep 2010;2. doi:10.3410/B2-3.
10. Francis JH, Jaben K, Santomasso BD, Canestraro J, Abramson DH, Chapman PB, et al. Immune Checkpoint Inhibitor-Associated Optic Neuritis. Ophthalmology 2020;127(11):1585–9. doi:10.1016/j.ophtha.2020.05.003.
11. Boisseau W, Touat M, Berzero G, Savatovsky J, Marabelle A, Touitou V, et al. Safety of treatment with nivolumab after ipilimumab-related meningoradiculitis and bilateral optic neuropathy. Eur J Cancer 2017;83:28–31. doi:10.1016/j.ejca.2017.05.036.
12. Kim JM, Materin MA, Sznol M, Kluger HM, Weiss S, Chow J, et al. Ophthalmic Immune-Related Adverse Events of Immunotherapy: A Single-Site Case Series. Ophthalmology 2019;126(7):1058–62. doi:10.1016/j.ophtha.2019.01.031.
13. Wilson MA, Guld K, Galetta S, Walsh RD, Kharlip J, Tamhankar M, et al. Acute visual loss after ipilimumab treatment for metastatic melanoma. J Immunother Cancer 2016;4(1):66. doi:10.1186/s40425-016-0170-9.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2025 Mayur Miruliya